Claims Examiner (Healthcare)
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
TL;DR
Claims Examiner (Healthcare): Reviewing, researching, and resolving complex provider disputes for health plans with an accent on Medi-Cal and commercial insurance claims adjudication. Focus on maintaining 98%+ accuracy in claims processing, interpreting regulatory requirements, and ensuring compliance with HIPAA and internal policies.
Location: Must be based in Makati, Philippines. Role requires in-office training with potential for remote work thereafter, subject to performance and business needs.
Company
is a leading provider of back-office support technology and tech-enabled outsourced services for healthcare plans, processing millions of claims annually through its proprietary workflow platform.
What you will do
- Investigate and resolve provider disputes regarding denied, underpaid, or incorrectly processed claims.
- Utilize EZCap and other adjudication systems to review claims history and adjudication data.
- Interpret health plan policies, provider contracts, and regulatory requirements including Medi-Cal and commercial plans.
- Verify eligibility, coverage, CPT codes, and supporting documentation for Medicare claims.
- Identify discrepancies to determine claim approval, denial, or adjustment based on medical necessity.
- Maintain 98%+ accuracy in claims adjudication while meeting strict turnaround time and quality standards.
Requirements
- Must be based in or near Makati, Philippines for initial in-office training.
- 3–5 years of hands-on experience in provider dispute resolution, claims processing, or adjudication within healthcare or health plan settings.
- Proficiency in CPT, ICD-10, and HCPCS coding validation.
- Experience with claims adjudication systems such as IDX or Facets.
- Strong knowledge of HIPAA, data privacy regulations, and cybersecurity standards.
- Advanced Excel skills and ability to start ASAP.
Culture & Benefits
- HMO medical and dental coverage starting on Day 1 (including 1 dependent).
- Transportation and internet allowances provided.
- Company-provided equipment for remote work.
- Opportunity to work with a mission-critical partner for over 70 health plans.
Будьте осторожны: если работодатель просит войти в их систему, используя iCloud/Google, прислать код/пароль, запустить код/ПО, не делайте этого - это мошенники. Обязательно жмите "Пожаловаться" или пишите в поддержку. Подробнее в гайде →